Inc.

CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Site Remediation, Omaha, NE

EPA

ASW Associates Inc Certification for Property Closeout

BVID

Field Work Started

16624

9-Oct-06

Property Address

Field Work Completed

2354 S 33rd Street

27-Oct-06

Summary:

The excavation was performed in compliance with the work plans and specifications.

The F2 quadrant was excavated to a depth of 6 inch.

The B2 quadrant was excavated to a depth of 6 inch.

The DZ quadrant was excavated to a depth of 6 inch.

Verification samples confirmed that the cleanup standards were met.

Verification samples were collected from the bottom of excavation.

The site was backfilled with materials which meets contract specifications.

The backfill was compacted to acceptable standards.

Sod placements and site restorations were conducted in compliance with work plans and

specifications.

40261720

Comments:

None. SUPERFUND RECORDS

Other: ^7 Z. y

Jan Prawdzik

Name

ASW Project Manager

Title 'Date Signarare
CONTRACT # EP-R7-06-04

ASW Associates Inc.

Omaha Lead Siite Remediation, Omaha, NE

EPA

Analytical Result Summary

OLS ID: 16624

rd

Property Address: 2354 S 33TM Street

Sample ID

16624-DE-DZ-06

16624-DE-F2-06

16624-DE-B2-06

XRF Results

Avg.

(ppm)

164.3 ±48.3

67 ± 42.6

222 ± 54.3

Lab

Results

(ppm)

NA

NA

NA

Jan Prawdzik

Name

ASW Project Manager

Title bate SIgnati/fe

Sample Designation

OLSID-DE-Location-dd

OLSID is a particular residential property ID from which the sample is collected.

- DE = During and Post Excavation

Location of the sample as follows;

Fl = Front Yard (1° Quadrant)

BI = Back Yard (1" Quadrant)

F2 = Front Yard (2nd Quadrant)

B2 = Front Yard (2"1 Quadrant)

DZ = Drip Zone

PZ = Play Zone

GA = Garden

EA = Easement

dd describes the depth from which the sample was collected.

NA = Not Applicable
&EPA "TfrRemediation/Excavation Contract (ASW)

EPA Property Close Out Form

Property #:

Date/Time:

Quads Excavated:

I 6 b 2 t/ / /

72 . £2 •/

Property Address:

Owner's Name: _

Contractor Group

5 3 3

Lc<>o/ €

Excavation General Yes No

1 . If necessary, were the correct quadranl(s) excavated and restored?

2. If necessary, were the correct areas of drip zone excavated and restored?

V

^/

Grading Sod and Vegetation Yes No

1 . Does the grading around the perimeter of the house in excavated areas generally slope away

from the house?

2. Has sod been laid in all areas that wen; excavated?

3. Does the sod appear to be generally healthy and growing? (Only evaluate if inspected at a 30

day time period)

4. Are sodded areas generally firm and evenly graded?

5. Are the joints between the sod strips generally tight? (Only evaluate if inspected at a 30 day

time period)

6. Was the property graded such that waier will not pool on the property?

7. Was damage to landscaping or plant materials avoided?

(S

(/

lX

v/

\/

/

Gates, Fences and Retaining Walls Yes No

1 . Do gates open and close freely? (If applicable)

2. Were all gates or fences taken down during restoration activities

flo Qata

reinslalled?^flf applicable)

3. Was damage to gates or fences avoided? (If applicable)

4. Was damage to retaining walls avoided? (If applicable)

V

I/

I/

I/'

Foundation, Siding and Gutters Yes , No

1 . Was damage to the siding or trim avoided?

2. Was damage to the foundation avoided?

3. Was damage to windows avoided?

4. Was damage to windows or door screens avoided?

5. Was damage to downspouts or downspout extensions avoided?

}/

\s

V

\y

^

/

/

/^

/

Sidewalks and Driveways (Concrete) Yes No

1 . Was damage to driveway surfaces avoided?

2. Was damage to walkway surfaces avoided?

J

/

J
Owners comments:

Inspection notes:

Removal and restoration activates

EPA Representative

iding the 30-day sod warranty:
f

Contract No: EP - R7 - 06 - 04

Property Closeout Agreement

Omaha Lead Superfund Site

CsSdi

OLSID

Pr.p.r.y <>„,,„ >^*. J(?

Property Address

s. 33 si

Is the Resident the Owner D Yes 89- No

Compliance Statement:

U.S. Environmental Protection Agency (EPA) or its authorized representatives, (or its contractors), to enter

and conduct environmental restoration services for the Omaha Lead Site.

Your cooperation in giving EPA/ASW permission to access your property during the removal/restoration

phase is sincerely appreciated. This document certifies that all work performed at this property was

completed in accordance with the contact specifications and EPA requirements.

If you have questions or need additional information please contact the EPA Public Information Centers at

(402) 731-3045 or (402) 991-9583 or the EPA Office of External Programs at 1-800-223-0425.

Additional Comments by EPA and/or ASW:

CONTRACTOR CERTIFICATION

Jan Prawdzik ASW Project Manager

Name Title Date

Property Owner Section

Signature

This agreement documents the completion of remedial/restoration efforts at the property to my satisfaction

B. I agree that restoration is completed at my property

D I Do Not Agree: Comments:

x

^'hj/vj^fhJL?

( Property Owner's Signature

^JQM*A xJ^l/AXvV^ t&\s

I HP A Representati^e/>ignature

it/oifaL

Date

n loiloL

Date
Page 1 of

U.S. Environmental Protection Agency Region VII

Omaha Lead Site

Omaha, NE

Residential Yard Soils

Environmental Restoration

Services

Grantor (the property owner), consents to and authorizes the United Sates Environmental Protection Agency (USEPA)

or its authorized representatives (or its contractors), the Grantee, to enter and perform certain environmental response

activities upon the following described premises. For further information please contact EPA at 1-800-223-0425.

Property Access Granted By ; ft

(Please Print Name)

t

(Property Owfcr Signature) ^~~ *~~J I (Date)

NOTE: Granting permission DOES NOT necessarily imply your property will be remediated at this time.

PROPERTY INFORMATIO N

etecl bv resident unu or —Plense

Resident Name: ic£. Jg,

Residence Address: 3> 5 *f S. 33

JS. Owner

Oifrl/IM

D Renter

Ate

(CITY) (STATE) (ZIP)

Property owned by: -U c?/d/Q ( CY LoSo\£

Owners mailing address:

Owner's telephone number — Home: j-Qj- Work:

Age of Home? _ <D Q _ years How long have you lived here? _

5/YES

ffl^YES

years

Has the exterior been painted or covered with siding since 1978

Has the interior been painted or covered since 1978?

Total number of occupants:

D NO

D NO

List Ages: "£ EffJA a €ft 5

List ages of occupants under 6 years old who pla> in the yard for 5 or more hours per week:

/

Comments:

AUTHORITY FOR ENVIORNMENTAL RESPONSE ACTIONS

The activities to be implemented by EPA under this agreement are pursuant to Section 104 of CERCLA, 42 U.S C. 9604. EPA's right of access to the

property for in Section 104(e) ofCERCLA, 42 U.S.C. 9604 (e), which provides entry for, "determining the need for response, or choosing or taking

any response action under this title, or otherwise enforcing the provisions of this title."

Access Attempts:

First: Second: Third:
List of existing Conditions pg. _ of

Property Address: S. 33^

Owner: £>a/OdU LoSojg .J£ Date: OLS # :

Description:

7FT" /S J /)~-MX

Owner Signature:

Prin & Sigri

ASW Associates Inc.

Prio& Sign
A] y^l-r' 1 /"

Owner Name: QO*JAU) ~£.o s.e><-£ yfL

Address: 235~*f < "S3

 s^

(Diriaha

Site

Lead Site

Sketch

Phone: H:fci£- 07?¥ w:

\i .4 ^~->- c\"~2_ r\ -^

Exterior Paint

Q Poor

Q Not paint

North Arrow

- —

Sample Number

RYASCPXA-/t»fc2-V F1

RYBSCPXA-/W»2>» F2

RYCSCPXA-ffefcZ-1* B1

RDZSCPXA-/6»^4 DZ

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rcPZOCPXA- P2~

Lead

Concentration

Z b£ ppm

Sample „

Collected ^D

Samples Collected

Firm: ^&w <^-S

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Number of Samples = ! j j ! — i

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RF Unit:

Date:

Samples Analyze

/£? 3 7 BOO

sd

k: 138

fime: y^W?

Staff: £d

Legend: F1 = Front Left, F2 = Front Right, B1 = Back Left, B2 = Back Right DZ = Drip Zone, GZ = Garden, PZ = Play

All quadrants are as viewed from the street, racing property

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